Information Collection

Submit a Complaint - Small Business Intake User Experience Test

IC 224862 under ICR 201504-3170-002 · OMB 3170-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0042 can be found here:

Documents and Forms

Document Name Document Type
Information Sheet.pdf Other-Information
Moderator Guide.pdf Other-Moderator's Guide
Consumer Response - Small Business Intake Screener.pdf www.forsmarshgroup.com Form and Instruction
IC Template 3170-0042.pdf IC Template - 3170-0042 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Submit a Complaint - Small Business Intake User Experience Test	Agency IC Tracking Number:	DI00459

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Information			Information Sheet.pdf		Yes	No	Printable Only
Other-Moderator's Guide			Moderator Guide.pdf		Yes	No	Printable Only
Form and Instruction	NA	Consumer Response - Small Business Intake	Screener.pdf	www.forsmarshgroup.com	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Financial Sector Oversight

Privacy Act System of Records
Title: CFPB.005 Consumer Response System	FR Citation: 79 FR 2144

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	159	159
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IC Template - 3170-0042	IC Template 3170-0042.pdf	12/15/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.